<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Username')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-userName" data-rule="required" class="form-control" name="row[userName]" readonly="" type="text" value="{$row.userName|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Safe_years')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-safe_years" data-rule="required" class="form-control" readonly="" name="row[safe_years]" type="text" value="{$row.safe_years|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Num')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-num" data-rule="required" class="form-control"  name="row[num]" type="number" value="{$row.num|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Source')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-source" data-rule="required" class="form-control" name="row[source]" type="text" value="{$row.source|htmlentities}">
        </div>
    </div>
  
     <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">保单:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-source" data-rule="required" class="form-control" readonly="" type="text" value="{$row.type|htmlentities}">
        </div>
    </div>

 <!--      <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">保险公司:</label>
        <div class="col-xs-12 col-sm-8">
            <select  id="c-insurance_company" class="form-control"   name="row[insurance_company]">
            
                <option value="PINGAN" {if $row.insurance_company eq 'PINGAN'}selected{/if}>中国平安保险</option>
                <option value="PICC" {if $row.insurance_company eq 'PICC'}selected{/if}>中国人民财产保险</option>
                <option value="PICCNEW" {if $row.insurance_company eq 'PICCNEW'}selected{/if}>中国人民财产保险(新)</option>
                 
            </select> 
        </div>
    </div> -->
  
  
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Createtime')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-createTime" data-rule="required" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[createTime]" type="text" value="{:$row.createTime?datetime($row.createTime):''}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Activetime')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-activeTime" data-rule="required" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[activeTime]" type="text" value="{:$row.activeTime?datetime($row.activeTime):''}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
